Army Medical University, Chongqing, China.
Department of Urology, Xinqiao Hospital, Army Medical University, Chongqing, China.
World Neurosurg. 2023 Oct;178:e533-e539. doi: 10.1016/j.wneu.2023.07.115. Epub 2023 Jul 28.
To identify the incidence and predictors of postoperative dysphagia in patients who undergo anterior cervical spine surgery (ACSS) by utilizing the Eating Assessment Tool (EAT-10).
A multicenter prospective study was undertaken at three hospitals to evaluate patients undergoing ACSS between January 2021 and January 2023. Included patients were aged 18-80 years and were undergoing primary or revision ACSS. Dysphagia was assessed using the validated EAT-10 questionnaire. Patients with dysphagia were included in the observation group, and those without dysphagia were included in the control group.
Of the 343 patients enrolled, 50 patients (14.6%) had EAT-10 scores of 3 or more at the 6-month follow-up. In the univariate analysis, patients with dysphagia at 7 days had a longer operative time, were current smokers, had involvement of vertebral bodies at C4 and above, and underwent intraoperative neurophysiological monitoring. Patients with dysphagia at 6 months had involvement of vertebral bodies at C4 and above and underwent intraoperative neurophysiological monitoring. In the multivariate analysis to determine associations with prolonged dysphagia, only the involvement of vertebral bodies at C4 and above (odds ratio 3.883, 95% confidence interval 1.847-8.165, P = 0.001) and intraoperative neurophysiological monitoring (odds ratio 0.273, 95% confidence interval 0.080-0.931, P = 0.038) remained significant.
Dysphagia is common after ACSS, affecting more than 67.5% of patients at 7 days postoperatively, but over time, the incidence of dysphagia gradually decreases. Involvement of the vertebral bodies at C4 and above is a risk factor for dysphagia after ACSS, and intraoperative neurophysiological monitoring is a protective factor.
利用饮食评估工具（EAT-10）确定行颈椎前路手术（ACSS）患者术后吞咽困难的发生率和预测因素。
在三家医院进行了一项多中心前瞻性研究，评估 2021 年 1 月至 2023 年 1 月期间接受 ACSS 的患者。纳入的患者年龄为 18-80 岁，行原发性或翻修性 ACSS。使用经过验证的 EAT-10 问卷评估吞咽困难。有吞咽困难的患者纳入观察组，无吞咽困难的患者纳入对照组。
在纳入的 343 例患者中，50 例（14.6%）在 6 个月随访时 EAT-10 评分≥3。单因素分析显示，术后 7 天出现吞咽困难的患者手术时间较长，为当前吸烟者，C4 及以上椎体受累，行术中神经生理监测。术后 6 个月出现吞咽困难的患者 C4 及以上椎体受累，行术中神经生理监测。多因素分析确定与延长吞咽困难相关的因素时，仅 C4 及以上椎体受累（比值比 3.883，95%置信区间 1.847-8.165，P=0.001）和术中神经生理监测（比值比 0.273，95%置信区间 0.080-0.931，P=0.038）仍有统计学意义。
ACSS 后吞咽困难较为常见，术后 7 天超过 67.5%的患者发生吞咽困难，但随着时间的推移，吞咽困难的发生率逐渐降低。C4 及以上椎体受累是 ACSS 后吞咽困难的危险因素，术中神经生理监测是保护因素。
